Heparinised blood ionised calcium concentrations in horses with colic or diarrhoea compared to normal subjects

Our objectives were to 1) establish ionised calcium (ICa), C-terminal PTH and biologically active PTH (intact molecule) concentrations in blood from normal horses, 2) examine the stability of ionised calcium and acid-base values in stored equine heparinised blood and serum and 3) check the applicability of the formulas based on these parameters in certain disease states. Mean +/- s.d. % ionised calcium in heparinised blood of normal Warmbloods was 51 +/- 2.7 (n = 20) of total calcium, range 1.45-1.75 mmol/l (n = 15) at Michigan State University and 1.43-1.69 mmol/l (n = 20) at Utrecht University. Mean +/- s.d. EDTA plasma concentration for intact +/PTH in normal horses measured 0.6 +/- 0.3 pmol/l (n = 11). Both mean serum and the heparinised blood ionised calcium concentrations changed (not significantly) after 102 h storage at room temperature. Six cycles of freezing and thawing did not affect serum ionised calcium concentration significantly. Ionised calcium concentration and pH in heparinised blood of 20 normal Warmbloods were used to calculate the regression equation for the prediction of the adjusted ionised calcium concentration to a pH of 7.4. The linear regression equation found was: adjusted plasma ICa at pH 7.4 mmol/l = -6.4570 + 0.8739 x (measured pH) + 0.9944 x (measured ICa mmol/l). By means of this formula, mean adjusted ionised calcium concentration in heparinised blood calculated was 100% of the actual value given by the analyser in the normal horses. When using this formula in horses with colic or diarrhoea, mean adjusted ionised calcium concentration was underestimated by 0.2 and 0.3%, respectively. Furthermore, to adjust the measured ionised calcium concentration in heparinised blood to a pH of 7.4 in healthy as well as in 2 groups of diseased horses 2 formulas with a good prediction are now available.     

Changes in canine ionised calcium under three storage conditions

OBJECTIVES: To determine the ionised calcium concentration following aerobic collection of blood and to compare ionised calcium concentration and pH of heparinised whole blood and plasma at 48 hours following collection under three different storage conditions to assess if ionised calcium concentration can be measured retrospectively. METHODS: Blood was collected from 17 dogs for analysis of ionised calcium concentration and pH using a Rapidpoint 400 (Bayer) blood gas analyser. Blood was collected into a commercial preheparinised syringe and into a plain syringe, with subsequent transfer to a commercially available heparinised sample tube. Samples were analysed within 10 minutes, and the remainder was divided for storage. One aliquot was set-aside at room temperature for 48 hours, and the other was immediately centrifuged and the plasma divided for storage at room temperature and at 4 degrees C for 48 hours each. In all samples, ionised calcium concentration and pH were measured again at 48 hours after storage. RESULTS: There was no significant difference in ionised calcium concentration or pH between anaerobically and aerobically collected heparinised whole blood analysed within 10 minutes of collection. At 48 hours, ionised calcium concentrations had decreased under all storage conditions irrespective of the direction of pH change. CLINICAL SIGNIFICANCE: Ionised calcium concentration can be measured in aerobically collected samples within 10 minutes and at 48 hours after collection under the conditions described.     

Plasma concentrations of parathyroid hormone-related protein in dogs with potential disorders of calcium metabolism

The plasma concentrations of total calcium, ionised calcium, albumin, parathyroid hormone and parathyroid hormone-related protein (PTHrp) were measured in 25 dogs with lymphoma, nine dogs with primary hyperparathyroidism and seven dogs with adenocarcinoma of the apocrine gland of the anal sac. Plasma total calcium, ionised calcium, albumin and parathyroid hormone-related protein were measured in 18 clinically normal control dogs. The concentration of PTHrp was high in 12 of the 14 dogs that were hypercalcaemic because of an underlying malignancy but was within the reference range in all the control dogs, in the 17 normocalcaemic dogs with lymphoma and in the seven dogs which were hypercalcaemic because of a parathyroid adenoma.     

Subclinical hypocalcaemia in captive Asian elephants (Elephas maximus)

The hypothesis that hypocalcaemia may play a role in dystocia in captive Asian elephants (Elephas maximus) was investigated. The objectives of the study were to measure the total calcium concentration in elephant plasma; assess the changes in parameters of calcium metabolism during a feeding trial; investigate a possible relationship between calcium metabolism and dystocia; and assess bone mineralisation in captive Asian elephants in vivo. The following parameters were measured: total and ionised calcium, inorganic phosphorous and magnesium, the fractional excretions of these minerals, intact parathyroid hormone, 25-OH-D(3) and 1,25-OH-D(3). Radiographs were taken from tail vertebrae for assessment of bone mineralisation. The mean (sd) heparinised plasma total calcium concentration was 2.7 (0.33) mmol/l (n=43) ranging from 0.84 to 3.08 mmol/l in 11 Asian elephants. There was no significant correlation between plasma total calcium concentration and age. Following feeding of a calcium rich ration to four captive Asian elephant cows, plasma total and ionised calcium peaked at 3.6 (0.24) mmol/l (range 3.4 to 3.9 mmol/l) and 1.25 (0.07) mmol/l (range 1.17 to 1.32 mmol/l), respectively. Plasma ionised calcium concentrations around parturition in four Asian elephant cows ranged from 0.37 to 1.1 mmol/l only. The present study indicates that captive Asian elephants might be hypocalcaemic, and that, in captive Asian elephants, the normal plasma concentration of total calcium should actually be around 3.6 mmol/l and normal plasma concentration of ionised calcium around 1.25 mmol/l. Given the fact that elephants absorb dietary calcium mainly from the intestine, it could be concluded that elephants should be fed calcium-rich diets at all times, and particularly around parturition. In addition, normal values for ionised calcium in captive Asian elephants should be reassessed.     

Iatrogenic hypocalcaemia during parenteral fluid therapy of diarrhoeic calves

Acid-base balance and electrolyte concentrations, including ionised calcium, were monitored during intravenous fluid therapy of 11 collapsed diarrhoeic suckler calves aged five to 10 days. Six healthy calves of similar age and type were used to provide control data. All the diarrhoeic calves were severely acidotic (TCO2<12 mmol/litre). Isotonic sodium bicarbonate (1-3 per cent) was administered until the metabolic acidosis was half corrected, as indicated by the TCO2 increasing to 17 to 24 mmol/litre when the infusion was changed to an extracellular volume replacement fluid containing 144 mmol/litre Na+, 35 mmol/litre HCO3-, 4 mmol/litre K+ and 113 mmol/litre Cl- which was administered until the calf was discharged. Milk feeding was started as soon as the calf had a suck reflex. The treatment was successful in 10 calves. At admission the diarrhoeic calves were hypocalcaemic compared with the control calves, but their ionised calcium was significantly higher, with significantly less calcium being protein bound. Treatment with isotonic sodium bicarbonate resulted in a significant improvement in acid-base balance, but both total and ionised calcium decreased significantly, the decrease in ionised calcium being proportionately greater owing partly to a significant increase in the protein binding of calcium. The mean total, bound and ionised calcium concentrations were all significantly lower in the treated calves after they had received isotonic sodium bicarbonate than in the control calves. Further treatment with replacement fluid had no significant effect on any of the parameters apart from pCO2 which increased significantly. Milk feeding had no significant effect on plasma calcium concentrations. The calves' mean ionised calcium concentration was significantly lower at the end of the treatment than before it, but there was no difference in the mean total and bound calcium concentrations. The calves' mean plasma potassium and magnesium concentrations decreased significantly during the course of the treatment.     

Hemodynamic effects of ionized calcium in horses anesthetized with halothane or isoflurane

OBJECTIVES: To evaluate the effects of halothane and isoflurane on cardiovascular function and serum total and ionized calcium concentrations in horses, and to determine whether administration of calcium gluconate would attenuate these effects. ANIMALS: 6 clinically normal adult Thoroughbreds. PROCEDURE: Catheters were inserted for measurement of arterial blood pressures, pulmonary arterial blood pressures, right ventricular pressure (for determination of myocardial contractility), right atrial pressure, and cardiac output and for collection of arterial blood samples. Anesthesia was then induced with xylazine hydrochloride and ketamine hydrochloride and maintained with halothane or isoflurane. An i.v. infusion of calcium gluconate was begun 75 minutes after anesthetic induction; dosage of calcium gluconate was 0.1 mg/kg of body weight/min for the first 15 minutes, 0.2 mg/kg/min for the next 15 minutes, and 0.4 mg/kg/min for an additional 15 minutes. Data were collected before, during, and after administration of calcium gluconate. RESULTS: Halothane and isoflurane decreased myocardial contractility, cardiac index, and mean arterial pressure, but halothane caused greater depression than isoflurane. Calcium gluconate attenuated the anesthetic-induced depression in cardiac index, stroke index, and maximal rate of increase in right ventricular pressure when horses were anesthetized with isoflurane. When horses were anesthetized with halothane, a higher dosage of calcium gluconate was required to attenuate the depression in stroke index and maximal rate of increase in right ventricular pressure; cardiac index was not changed with calcium administration. CONCLUSIONS AND CLINICAL RELEVANCE: I.v. administration of calcium gluconate may support myocardial function in horses anesthetized with isoflurane.     

Effects of anesthetic agents on serum parathyroid hormone and calcium concentrations in mice

OBJECTIVE: To determine the effects of three anesthetic regimens on serum calcium and parathyroid hormone (PTH) in mice. STUDY DESIGN: Prospective experimental study. ANIMALS: Twenty-seven, 12-week-old, FVB mice. METHODS: Mice were anesthetized with either isoflurane, a combination of ketamine plus xylazine (100 and 10 mg kg(-1), respectively) or ketamine alone (100 mg kg(-1)). Blood was collected before and after the induction of anesthesia. Serum calcium and PTH concentrations were measured and compared. RESULTS: Isoflurane or ketamine did not significantly alter either serum calcium or serum PTH concentrations. A combination of ketamine plus xylazine significantly increased serum PTH, but not serum calcium concentrations. CONCLUSIONS: A combination of ketamine and xylazine should be avoided prior to collection of blood for measurement of serum PTH concentrations. Isoflurane is suitable for this purpose.     

Hypocalcaemia associated with low serum vitamin D metabolite concentrations in two dogs with protein-losing enteropathies

Protein-losing enteropathies were diagnosed in two dogs that were initially presented with diarrhoea and weight loss. Plasma biochemistry in both cases revealed low concentrations of albumin, calcium and ionised calcium. Both dogs had an elevated plasma parathyroid hormone concentration and low serum 25-hydroxyvitamin D (25[OH]D) concentration. The first dog was diagnosed with lymphangiectasia on postmortem examination, and the second dog was diagnosed with chronic lymphocytic/ plasmacytic enteritis and severe cystic mucoid changes based on endoscopic duodenal biopsies. While a causal effect was not demonstrated, the protein-losing enteropathies may have caused reduced intestinal absorption of vitamin D leading to low plasma concentrations of ionised calcium and secondary hyperparathyroidism. To the authors' knowledge, this is the first report of low ionised calcium concentrations, low 25(OH)D and 1,25-dihydroxyvitamin D concentrations, and high parathyroid hormone concentrations in dogs with protein-losing enteropathies.     

Formation of calcium complexes by borogluconate in vitro and during calcium borogluconate infusion in sheep

The effect of borogluconate on plasma calcium fractions was studied in vitro and in vivo in sheep. In vitro calcium chloride was more effective in raising ionised plasma calcium than calcium borogluconate. Sodium borate or gluconate added to blood caused only small decreases in blood ionised calcium. However, together, a synergistic reduction in ionised calcium was observed. Following calcium borogluconate infusions into sheep, total plasma calcium rose primarily because of an increase in the unionised ultrafiltrable fraction. Other changes observed following the infusion were hypercalciuria, decreased glomerular filtration rate and acidosis. Sodium borogluconate administered subcutaneously lowered total plasma calcium. This probably resulted from enhanced calcium excretion. It is suggested that since the anionic component of calcium solutions alters the availability and retention of calcium, it is likely to affect clinical efficacy significantly.     

Hypovitaminosis D in dogs with inflammatory bowel disease and hypoalbuminaemia

Objectives : To compare serum vitamin D metabolites and plasma parathyroid hormone concentrations in dogs with inflammatory bowel disease and normal albumin concentration, dogs with inflammatory bowel disease and hypoalbuminaemia, healthy dogs and hospitalised ill dogs with non‐gastrointestinal illness. Methods : Serum 25 hydroxyvitamin D and 1,25 dihydroxyvitamin D concentrations were measured in 36 healthy dogs, 49 hospitalised ill dogs with non‐gastrointestinal illnesses, 21 dogs with inflammatory bowel disease and normoalbuminaemia and 12 dogs with inflammatory bowel disease and hypoalbuminaemia. Plasma parathyroid hormone and ionised calcium concentrations were measured in a subset of these dogs. Results : Concentrations of serum 25 hydroxyvitamin D were lower in hypoalbuminaemic dogs with inflammatory bowel disease than in the healthy dogs (P<0·001), hospitalised ill dogs (P<0·001) and normoalbuminaemic dogs with inflammatory bowel disease (P<0·001). Dogs with inflammatory bowel disease and hypoalbuminaemia had a higher plasma concentration of parathyroid hormone (P<0·01) and lower plasma concentration of ionised calcium (P<0·001) than hospitalised ill dogs. Dogs with inflammatory bowel disease had a positive correlation between serum 25 hydroxyvitamin D concentrations and serum albumin (P<0·0001), serum calcium (P<0·0001) and plasma ionised calcium (P<0·0005) concentrations. Clinical Significance : Dogs with inflammatory bowel disease and hypoalbuminaemia frequently have ionised hypocalcaemia, high parathyroid hormone and low serum 25 hydroxyvitamin D concentrations. Further studies are indicated to establish the pathogenesis of this disease complication as well as therapeutic strategies to reverse this state.     

Short-term prednisolone therapy has minimal impact on calcium metabolism in dogs with atopic dermatitis

Glucocorticoids (GCs) are a large group of drugs used to treat a range of inflammatory, autoimmune and neoplastic diseases in dogs. Glucocorticoids have been linked to disturbances in calcium metabolism and skeletal disorders in humans, yet their effects at therapeutically effective dosages in dogs with spontaneous diseases are poorly understood. Serum concentrations of calcium, phosphate, vitamin D metabolites and plasma concentrations of parathyroid hormone and ionised calcium together with urinary fractional excretion of calcium and phosphate, were measured in 16 dogs with atopic dermatitis before and 6weeks after standard dosage prednisolone treatment (0.93-1.06mg/kg) every other day after 7days of treatment with the same dosage once daily. The severity of their physical signs, as assessed by the canine atopic dermatitis extent and severity index version 3 (CADESI-03) and the Edinburgh Pruritus Scale (EPS), decreased in all dogs following prednisolone treatment. There was no significant difference in any of the biochemical parameters measured following prednisolone treatment. This study indicates that prednisolone, used at a therapeutically effective dose, has minimal impact on calcium metabolism in dogs with atopic dermatitis.     

Diurnal variations in the plasma concentration of parathyroid hormone in dogs

The plasma concentrations of parathyroid hormone (PTH), ionised calcium (Ca(2+)), total calcium, albumin and inorganic phosphorus, and the pH were measured in blood samples obtained from nine dogs during a period of 26 hours. The plasma pth levels fluctuated slightly during the day, by about 20 pg/ml, but there was a distinct peak (42.8 [8.8] pg/ml) at 07.00. Plasma Ca(2+) showed a diurnal pattern in which two peaks (increases of 0.03 mmol/l) were observed at 05.00 and 17.00, and the plasma concentration of inorganic phosphorus showed a similar pattern. There were no diurnal changes in total calcium or albumin.     

Feline chronic renal failure: calcium homeostasis in 80 cases diagnosed between 1992 and 1995

Eighty cats with chronic renal failure (CRF) were evaluated in a prospective study to investigate the prevalence and aetiopathogenesis of renal secondary hyperparathyroidism (RHPTH), using routine plasma biochemistry and assays of parathyroid hormone (PTH), blood ionised calcium and 1,25 dihydroxycholecalciferol (1,25[OH]₂D₃). Hyperparathyroidism was a frequent sequela of CRF, affecting 84 per cent of cats with CRF, the severity and prevalence of RHPTH increasing with the degree of renal dysfunction. Compared with an age-matched control population, plasma concentrations of phosphate and PTH were significantly higher and 1,25(OH)₂D₃ concentrations were significantly lower in the two groups of cats presenting with clinical signs of CRF. Significant ionised hypocalcaemia was present only in cats with end-stage renal failure. However, a number of cats were hyperparathyroid in the absence of abnormalities in the parameters of calcium homeostasis measured in this study. There was a significant correlation between plasma phosphate and PTH concentrations.     

Hyperparathyroidism in dogs with hyperadrenocorticism

OBJECTIVES: To assess the effect of canine hyperadrenocorticism (HAC) on parathyroid hormone (PTH), phosphate and calcium concentrations. METHODS: PTH concentrations and routine biochemical parameters were measured in 68 dogs with HAC. Ionised calcium was measured in 28 of these dogs. The results obtained were compared with an age- and weight-matched group of 20 hospital patients that did not show signs of HAC. RESULTS: There were significant differences between the PTH, phosphate, alkaline phosphatase, creatinine and albumin concentrations between the two groups. Total and ionised calcium concentrations were not significantly different. Most of the dogs (92 per cent) with HAC had PTH concentrations that were greater than the reference range (10 to 60 pg/ml), and in 23 dogs they were greater than 180 pg/ml. There were significant positive correlations between the PTH and basal cortisol, post-adrenocorticotropic hormone (ACTH) cortisol and alkaline phosphatase concentrations, and also the phosphate and post-ACTH cortisol concentrations. CLINICAL SIGNIFICANCE: Adrenal secondary hyperparathyroidism is a cause of increased PTH concentrations and may be associated with abnormalities in calcium and phosphate metabolism in dogs with HAC. The findings of this study could explain why canine HAC may cause clinical signs such as calcinosis cutis that are associated with altered calcium metabolism.     

肉鸡腹水综合征患鸡右心组织钙含量的研究

利用原子吸收分光光度法和焦锑酸钾组化电镜技术,测定肉鸡右心室壁总钙和右心室组织细胞内游离Ca2+含量和分布。结果显示肉鸡腹水综合征患鸡右心室壁总钙含量为(71.2±6.5)mg/kg,显著高于低温未发病和健康肉鸡(分别为58.0±4.4,46.8±3.1,P<0.01)。电镜观察发现Ca2+沉淀颗粒主要散在分布于患鸡心肌胞浆、肌浆网、线粒体等部位,腹水综合征患鸡Ca2+颗粒的沉积量比健康肉鸡显著增多。结果提示心肌细胞内Ca2+的异常可能与肉鸡腹水综合征的发生发展有关。     

Cardiopulmonary and anesthetic effects of ketamine and its enantiomers in dogs

Dogs were used to determine cardiopulmonary and chemical restraining effects of racemic ketamine and its enantiomers. Levorotatory ketamine induced the shortest duration of unconsciousness and recumbency when compared with effects of dextrorotatory and racemic ketamine. Administration of racemic ketamine or either of its enantiomers (30 mg/kg of body weight, IV) to dogs recovering from isoflurane anesthesia induced transient, but significant (P less than 0.05), decreases in arterial blood pressure, left ventricular contractility, cardiac output, and total peripheral vascular resistance. Arterial blood pressure and left ventricular contractility significantly (P less than 0.05) increased at later times after ketamine administration. Arterial pH and the PO2 values decreased after IV administration of racemic ketamine or its enantiomers. Significant differences in cardiopulmonary variables were not observed between groups given ketamine or its enantiomers.     

Hemodynamic Effects of Calcium Gluconate Administered to Conscious Horses

Calcium gluconate was administered to conscious horses at 3 different rates (0.1, 0.2, and 0.4 mg/kg/min for 15 minutes each). Serum calcium concentrations and parameters of cardiovascular function were evaluated. All 3 calcium administration rates caused marked increases in both ionized and total calcium concentrations, cardiac index, stroke index, and cardiac contractility (dP/dt_max). Mean arterial pressure and right atrial pressure were unchanged; heart rate de creased markedly during calcium administration. Ionized calcium concentration remained between 54% and 57% of total calcium concentration throughout the study. We conclude that calcium gluconate can safely be administered to conscious horses at 0.1 to 0.4 mg/kg/min and that administration will result in improved cardiac function.     

The effect of oral calcium lactate in postpartum cows

The oral administration of calcium lactate for prophylaxis of bovine parturient paresis has been promoted for a number of years. The goal of the present study was to investigate the effect of this treatment on the serum concentrations of calcium, inorganic phosphorus and magnesium in parturient cows. Five fresh calved cows were given a drench containing calcium lactate and 5 control cows received the same drench but without calcium lactate. There were no significant differences in the serum concentrations of total and ionised calcium and magnesium between treated and control cows within 24 hours of treatment. Because the calcium lactate drench did not significantly affect calcium concentrations in the blood of fresh cows, it appears highly questionable whether the administration of calcium lactate decreases the risk of bovine parturient paresis. Based on our results, the oral administration of calcium lactate can not be recommended for prophylaxis of bovine parturient paresis.     

Study of calcium homeostasis in feline hyperthyroidism

Thirty cats with untreated hyperthyroidism were blood sampled and their calcium homeosta-tic mechanisms and renal function assessed. The results were compared with those obtained from 38 age-matched control cats. The hyperthyroid group of cats were found to have significantly lower blood ionised calcium and plasma creatinine concentrations and significantly higher plasma phosphate and parathyroid hormone concentrations. Hyperparathyroidism occurred in 77 per cent of hyperthyroid cats, with parathyroid hormone concentrations reaching up to 19 times the upper limit of the normal range. The aetiology, significance and reversibility of hyperparathyroidism in feline hyperthyroidism remains to be established but could have important implications for both bone strength and renal function.     

Paresis and unusual electrocardiographic signs in a severely hypomagnesaemic, hypocalcaemic lactating bitch

A severely hypocalcaemic, hypomagnesaemic lactating bitch exhibited clinical signs of pulmonary oedema, paresis, dementia, gastrointestinal ileus and urinary bladder atony. The total calcium, ionised calcium and magnesium levels were extremely low. The clinical picture was very different from the one typically encountered in canine lactation tetany, and instead resembled bovine postparturient paresis. Muscle tremors, rigidity and seizures were not part of the acute clinical picture, but rather atony, weakness and paresis. General muscle dysfunction probably resulted from the extremely low ionised calcium levels in combination with very low levels of magnesium and possibly potassium. Heart failure and atony of the urinary bladder and intestines were probably a result of the severe hypocalcaemia. The alteration in calcium to magnesium ratio may have depressed neuromuscular transmission, leading to paresis and atony. The unusual electrocardiogram possibly also resulted from abnormal magnesium and calcium cation levels.